Inhaler for agitation

[Igor4sugry]

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I'm not sure if some of you know of inhaled Loxapine (Adasuve) that got approved in Dec 2012 for agitation.

I haven't seen it used in our hospital. But it is hard for me to picture why this even got approved. It comes in an inhaler with somewhat complicated instructions. You also need to make sure patient does not have COPD or Asthma due to some bad bronchospasm events.

http://medlibrary.org/lib/rx/meds/adasuve/

What do you guys think of this?

 

[BobA]

I'm not sure if some of you know of inhaled Loxapine (Adasuve) that got approved in Dec 2012 for agitation.

I haven't seen it used in our hospital. But it is hard for me to picture why this even got approved. It comes in an inhaler with somewhat complicated instructions. You also need to make sure patient does not have COPD or Asthma due to some bad bronchospasm events.

http://medlibrary.org/lib/rx/meds/adasuve/

What do you guys think of this?

It would seem that any patient who would willingly (and be able to) follow the instructions of using an inhaler would not need it, right? If they have intestinal absorption issues then a SL med could be used and would be safer. It's hard to see how inhaled loxapine could be helpful (ESP given the risks).

 

[billypilgrim37]

When agitated, plenty of times we'll offer patients the option of PO med versus IM if they aren't dangerously out of control. Sometimes patients have decent insight into the fact that they're very agitated and, without intervention, something bad might happen. My understanding of the inhaled was that the onset was much faster than PO, so you'd get the benefit of the IM without having to actually have a shot. Some folks PREFER the shot because they know it will work more quickly than PO. Those are the folks that MIGHT benefit from something like this.

I'm not saying that I'm buying it. But there is some rationale, if it works the way they want us to think it will.

 

[vistaril]

When agitated, plenty of times we'll offer patients the option of PO med versus IM if they aren't dangerously out of control. Sometimes patients have decent insight into the fact that they're very agitated and, without intervention, something bad might happen. My understanding of the inhaled was that the onset was much faster than PO, so you'd get the benefit of the IM without having to actually have a shot. Some folks PREFER the shot because they know it will work more quickly than PO. Those are the folks that MIGHT benefit from something like this.

I'm not saying that I'm buying it. But there is some rationale, if it works the way they want us to think it will.

dude....read what you just wrote. You clearly don't buy it, but for some reason you're trying to convince yourself that you should buy it. If something is bull****, don't be hesitant to call it out as such.

 

[billypilgrim37]

I think being skeptical but open to being wrong is a perfectly good approach to clinical decision making. They make a claim, I find it possible but not likely.

Sent from my DROID RAZR using SDN Mobile

 

[nitemagi]

They did one of the trials at my old hospital. It was like watching an agitated pt. take a drag on a joint (at least at the time it was shaped like a cigarette too).

 

[heyjack70]

It would seem that any patient who would willingly (and be able to) follow the instructions of using an inhaler would not need it, right? If they have intestinal absorption issues then a SL med could be used and would be safer. It's hard to see how inhaled loxapine could be helpful (ESP given the risks).

Is the SL Saphis? Are there other antipsychotics that get absorbed across the oral mucosa? I know the M-tabs and Zydis dissolve in the mouth but are still absorbed in the gut. Has anyone used Saphris for acute agitation?

 

[BobA]

Is the SL Saphis? Are there other antipsychotics that get absorbed across the oral mucosa? I know the M-tabs and Zydis dissolve in the mouth but are still absorbed in the gut. Has anyone used Saphris for acute agitation?

I used it once bc the pt was already on it and agreed to take it, but it didn't seem to work. The problem with SL is the pt has to agree to hold it under their tongue while it dissolves. Again- probably not that agitated if they are willing and able to do this.

There's also SL Lorazepam and Clozapine but I'm not sure if they are absorbed SL or in the gut.

 

[BobA]

dude....read what you just wrote. You clearly don't buy it, but for some reason you're trying to convince yourself that you should buy it. If something is bull****, don't be hesitant to call it out as such.

What is the purpose of attacking BP? It creates a bad vibe on the boards. No one likes bad vibes.

Why not just state your own opinion, while respecting the right of others to express their opinion?

 

[notdeadyet]

.

 

[billypilgrim37]

I definitely appreciate the backup, though I think Vistaril has very much toned himself down. He's gone from "dude that disagrees about everything and is a total wiener about it" to "dude that disagrees about everything but isn't quite so excited to be a wiener about it." He doesn't immediately ruin threads as soon as he joins them like he used to. So, baby steps, but I think we should recognize a touch of improvement with his tone.

And even what he said here, I could imagine a friend saying that same thing to me with a smile on their face and it would be okay. He lets me tease him some and he teases back, so I think we can have hope for our cantankerous friend!

 

[Armadillos]

They did one of the trials at my old hospital. It was like watching an agitated pt. take a drag on a joint (at least at the time it was shaped like a cigarette too).

Now if they just developed a smokable form, would do wonders for compliance

 

[heyjack70]

Now if they just developed a smokable form, would do wonders for compliance

patent this asap.

 

[shan564]

patent this asap.

dibs.

All you need to do is find a way to make it grow in the dirt. Then you'll have people lining up to smoke it.